Should paramedics undertake an additional scope of practice


Ambulance services and the healthcare professionals that provide the support to facilitate this provision are playing an increasingly wide role in the NHS, not just by providing a rapid response to 999 calls and transferring patients to hospital but becoming a portable healthcare service for the NHS. The ambulance service continues to develop and like other clinical specialties within the NHS the practitioners employed within the ambulance service have had to developed knowledge, skills and an understanding of modern technology in an attempt to take healthcare to individuals outside of the hospital environment. It is suggested that ambulance services reach a wide range of patient groups; for example to patients who need an emergency response; to individuals who do not have a life threatening condition but are seeking urgent advice or treatment, and to those whose condition or location prevents them from travelling easily to access healthcare services (Warner, 2005).

Traditionally ambulance services have been primarily perceived as an emergency service where the response is to meet the needs of individuals who may be experiencing life threatening emergencies, with severe breathing difficulties, acute coronary syndrome or suffering major trauma (Lendrum et al,. 2000). Training and service development has been structured to reflect this need for emergency acute care, however a paradigm shift has occurred with focus now being made upon more care and treatment being provided within community settings and within patients homes and the traditional perceptions of the ambulance service are gradually being replaced with the view that it is a mobile health resource, able to provide an increasing range of assessment, treatment and diagnostic services (Department of Health, 2005).

This assignment will aim to explore further these developments in ambulance service provision, emergency care and the developing paramedic professional scope of practice by using the example of an 8 year old boy who had sustained a head wound. The child in question had on initial examination a small laceration above the right eyebrow, his GCS score was 14 and he was able to self report on paediatric pain chart that the wound ‘only hurts a little’. The injury was reported to have been inflicted following a fall whilst ‘play fighting’ with his brother. Historically it would be accepted practice for the ambulance personnel to transfer the child with an appropriate adult to the acute hospital setting for further treatment of the wound, however for the purpose of this assignment and in light of the developing role of the paramedic and ambulance service the focus will be on how the process of home treatment and intervention in a safe and appropriate clinical manner could have been delivered to minimise the use of acute hospital resources and for the patient to receive wound care within their own home and community.

Ambulance Services and Children

It is suggested in the literature that 5 to 10% of calls made to the ambulance service are for children (Jewkes, 2004a, Jewkes, 2004b and Kumar et al,. 1997) and that as this figure is relatively small this may be translated to imply that a paramedics exposure to children who are critically ill or injured would likely to be infrequent (Houston and Pearson, 2010). With this in mind it may be suggested that there is the potential for ongoing difficulties with the implementation of clinical skills in the paramedic’s practice, particularly if those skills are relevant and have been acquired in paediatrics and care of the sick child, if they are not used or practiced often enough.

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